F.E.A.S.T's Around The Dinner Table forum

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joanne34
Hi, is this common? Since moving to re-feeding we've had tears etc after food but she has always eaten the food given. Tonight our daughter got very upset and I found her in her bedroom scratching her arms with her finger nails. She admitted it wasn't the first time. It has been a common event as her arms aren't scarred etc.  Have any of you had to cope/deal with this? We had a long talk where after she felt happier but now I am even more worried than I was with the anorexia. Our appointment with the eating disorder clinic isn't for another 6 days and I am really worried as she is 170 cm but only 43kg. 
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Enn
Hi yes it is common. It can be a way to externalize her upset. 
please ensure that meds, poisons,
sharps, tools etc are hidden and she and other family members are safe. 
Some have used ice cubes, or even markers to draw on themselves. It is still physical and may alleviate the need to hurt herself. If this happens right after a meal, distraction and sitting with her may help as well. 
The fact she is open to talking to you is a good thing. Allowing her to share her feelings may help too. 
Is there a mental health hotline you can call as well, to get some support. Is the doctors office available ? 

We did not have this. But many have. I know they will be here to share soon.
also use the search button (magnifying glass ) to search this topic as you may get more information.
i can imagine how hard this is right now without a team in place. 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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joanne34
Thank you. The team response is contact A and E if they are not available. After talking she has calmed but I feel now I'll be watching her more like a hawk now!
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Lexi123
Hi, 

This is common. I agree with Enn on the ice cube trick or even using ice packs on her face after the meal. The cold can help disrupt the thought patterns. Something else that helped my D was painting her nails, drawing, knitting, or anything that kept her hands busy. It is very distressing, I know, but I’m glad she was able to be honest with you.
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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Enn
Here are some ideas:
https://www.google.ca/amp/s/m.wikihow.com/Stop-Self-Harming%3famp=1
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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joanne34
Thank you so much xx
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Foodsupport_AUS
Yes, unfortunately self harm is a very common part of eating disorders. You should also be aware that suicidal thoughts are relatively common and more common in those with self harm behaviours. It is very distressing to see our children harming their bodies in yet another way. Trying to limit access to things that can be used is helpful though I found it almost impossible to stop self harm in my own D for sometime.

This post from the Hall of Fame has some good information https://www.aroundthedinnertable.org/post/self-injury-5858696?pid=1273650354

She may feel very much in two minds about stopping the self injury. It can be a way for her to express her distress at what is going on. There are a number of sites which discuss other ways of dealing with the distress other than through a physical cut or scratching - ice cubes is just one option. 

There are some other strategies listed on this site https://www.psychologytoday.com/au/blog/the-truth-about-exercise-addiction/201708/15-things-do-instead-self-harming

and more here too https://www.medicalnewstoday.com/articles/324515.php#9-ways-to-stop-cutting

I also found letting my D know that I heard her distress, and being aware of how miserable she was, allowed her to let me know of what was happening so we could manage each issue as it cropped up. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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sandie

Hi yes we had this for a few weeks. It involved D slapping her legs repeatedly so hard they bruised and hitting her head against the wall. I was horrified and it was explained to me that this was her way of expressing her distress. 

I remember what worked here was I told the therapist in front of her what was happening and she was mortified. I said self harm was so serious I would have to tell her teacher as well. My D hated the notion of others knowing and she stopped. I don’t know if that sounds a bit threatening of me. But it worked. I think it was about showing my D what the boundaries were- this was a line she wasn’t allowed to cross. Sending you a hug. Xx

Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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ValentinaGermania
Please check her room and lock away everything that can be used for self harm (do not forget her pencil case and the compasses and even paper clips - my d used those). Also no blades in the bathroom any more or only to use with supervision (for shaving). Put away all knifes and scissors and other sharp things.
My d started self harm in IP and we got rid of it with a punching bag to take all that anger and frustration to it, but in that bad state your d is at the moment she will only lose precious energy with that. Try to monitor her 24/7. That is most important at the moment. Do you have a blood pressure machine or can you lend one? Can you control her pulse at least twice a day? Please take her to A&E if her pulse is below 50.
Keep feeding. There is light at the end of the tunnel.
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joanne34
Thanks, I've already moved anything iffy. I've checked her pulse daily and it has been fine. I'm hoping to get her bp checked soon but she hasn't shown signs of low BP at the mo. 
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ValentinaGermania
It is not only about signs of low blood pressure. If you messure it first lying and then standing (after about 3 minutes later) it should not differ more than 10. If it does this can be a sign for serious heart issues. (search for "orthostatic blood pressure")
You can only stop self harm by 24/7 supervision and as much distraction as possible. Put her in front of TV all day if necessary 🙂. Netflix can be your best friend at the moment...
What helps also is when you give her something to do with her hands. When the hands are busy the brain gets rid of some of the stress I saw here. I gave her puzzles, handcrafts or asked her to help me in the household (which also helped her to feel not that guilty about us).
Keep feeding. There is light at the end of the tunnel.
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Torie
Hi Joanne, We are another family who had to deal with self-harm.  Ugh!

I tried really hard to understand what the heck this was about - was she doing this because of all the self-loathing and belief that she should be punished?  Or was she doing it because - as I have read - it provided some kind of relief from her suffering?  I never figured that out.

The great thing was that her urge to self-harm melted away when she had been weight restored for a while.  There is no guarantee that weight + time will resolve this, but there is much reason to HOPE it will.

In the meantime, it is terrible, I know.  I'm so sorry you and your d are going through this.

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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teecee

Hello and welcome. My AN D was suicidal so we had a safety plan which included getting a lock on a cupboard door with all poisons, cleaning fluid, sharps and medicine in there for months. When she had extreme episodes we only had to worry about hiding the key. 

Also try asking her to wear an elastic hair bobble as a bracelet which she can flick as oppose to actually hurting herself. That may eliminate some of the anxiety. 

Please ask if you need any more suggestions as we all have many ideas to assist. 

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joanne34
Thank you again for all of your responses. When I caught her doing it she seemed quite ashamed and did apologise later. Her arms are clean and were mark free once the scratches calmed down. I have said that when we have the eating disorder meeting with CAHMs this will have to be mentioned. I have been taking her pulse lying/sat down and standing up. Her resting pulse ranges from 60-72 bpm which is fairly normal for an active child of her age. I am concerned about her standing pulse as it does increase by around 30 bpm even after 3 mins and her pulse in her wrist feels a bit thready, definitely not as strong as when she is sat/lying down. I'm going to try and get her in with the gp to check pulse and bp. The original gp only checked her pulse once sitting down the first time he saw her. Clearly not thorough enough. I will ask about an ECG too. Her bloods came back ok but her finger tips and toes go blue v easily. 
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teecee
Hi Joanne
pleased you seem ok and on top of it. Just be aware that CAMHS do different bloods than hospital and GP. My Ds illness and poor health wasn’t picked up by either hospital or GP and the GP questioned why CAMHS were asking for certain bloods. When the results came back there were some abnormalities (that were resolved). 
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Enn
Hi Joanne,
Her blue cold extremities are
common and so is feeling cold all the time.
please keep her warm. As the body starts getting more nourishment the metabolism may speed us and she may get quite warm
and have night sweats. 

The increase in heart rate is telling it can be she is dehydrated and her blood pressure can be quite low while standing. You
mention her resting heart rate for an ‘active’ child. I would consider that all activity be held right now as her heart rate increased just with standing. 
If you feel she is unwell please consider taking her to A and E. 
Is she eating for you and what is she eating? If possible try to increase the caloric intake by 200 to 300 cal per day every 3 days. 
Are you aware how many calories she is getting right now? That will be helpful for your team to know. So that they do not start at a lower intake when they see her. It also helps you and them know what she will need to gain.

Labs are usually normal unless there is purging or laxative abuse. 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Enn
http://www.gaudianiclinic.com/gaudiani-clinic-blog/2015/12/21/why-feeling-cold-can-be-a-dangerous-sign-in-anorexia-nervosa
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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joanne34
Thanks. By active I mean prior to being aware of her anorexia she danced several times a week so was pretty fit. We have curtailed activity/exercise whilst trying to re-feed. She is eating all of her three main meals and I am trying to introduce snacks. On average I think she is eating 1500-1600 at the mo. At her worst she was skipping breakfast and dinner and at times trying to restrict herself to 500 cals so it is a step forward but I know the calorie intake still needs to increase. She is aware of the meal plan cahm will introduce and hopefully with the 'official' assessment she will move to being on board with that. I am also trying to get her to drink more as when she had her blood test it was evident she was fairly dehydrated. This site is so useful, I am getting so much relevant info. Thank you xxx
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Torie
Hi Joanne, it sounds like you (and your d!) are really making good progress. It's great that you have curtailed the activity and have been able to increase the calories already.

"She is aware of the meal plan cahm will introduce and hopefully with the 'official' assessment she will move to being on board with that."

I hope you will be among the lucky few whose kid is on board with the treatment plan, but please know that you can drag her back to health whether she is on board with that or not.

"I am trying to introduce snacks."

Good idea!  Would you like help brainstorming ideas for this?  

"I am also trying to get her to drink more" 

Another good idea!  Most here require full fat milk or caloric juice (like grape juice).  Smoothies and shakes can pack in a lot of calories.

Keep up the good work! xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
Joanne34 please don't expect your D to get on board when you have the CAMHS visit. I too thought that surely if my daughter would see sense, see how ill she was and would then work with me to try to get better. This illness is illogical and it is common if not normal for those who are ill to markedly down play or deny the severity of their illness (anosgnosia) and it is also very common if not normal for them to not be able to be on board with treatment. CAMHS is also very variable in quality with some people receiving great treatment in the UK and others receiving terrible treatment, which is sometimes not very helpful at all. What you are doing right now is the most important thing early on. Renourishing her starving body. Please do get further assessment for medical instability, the rises in her pulse can be a sign that she is at risk of heart problems. 

You have done a great job of slowly increasing the amounts of food. If at all possible I would be sticking with you "meal plan" rather than hoping that one from CAMHS is somehow going to be better. True FBT does not use a meal plan, rather it leaves you the parent deciding how to nourish your child. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Torie
If at all possible I would be sticking with you "meal plan" rather than hoping that one from CAMHS is somehow going to be better.

That's a great point, Foodsupport.  It took me a while to figure out that I needed to take charge the same way I took charge when she was a toddler.  She (D) didn't make any of the feeding decisions; the pediatrician didn't make any of the feeding decisions; I was the mom and it was my job to make the feeding decisions.  It is weirdly like having a toddler again - and my d was 15.  Since your d is 12, it might be slightly less weird to take charge like this. I "just" needed to make the calls, and she "just" needed to eat and drink whatever I said she needed to consume.

As the good folks here reminded me: "You are her mom, and you have fed her her whole life.  You will figure out exactly what she needs, just like you always have."

Keep swimming. xx

-Torie 
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
This can help you to figure out what the GP should do: https://www.aedweb.org/resources/publications/medical-care-standards
Keep feeding. There is light at the end of the tunnel.
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joanne34
Thank you. I am contacting the GP tomorrow regarding physiological symptoms but I'm also concerned the anxiety has increased as she is now getting upset/tearful before eating food. We are still getting her to eat it but it is a change as before she was low/upset after now it is before and after. 
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ValentinaGermania
It is normal that the anxiety increases. AN therapy is mostly exposition therapy. She must learn that nothing bad happens when she eats a muffin but that means she must go through that experience first. Try to distract her as much as possible. Here eating in front of TV helped a lot. To be honest, on most days we literally lived in front of TV at the start.
If she has survived eating that muffin about 20 times and nothing bad happened her brain will learn again that food is not dangerous. But this takes time.
I fear she must go through that episode and you can only try to comfort her and make it easier but you cannot avoid that this will happen. Here in Germany we have a say that you cannot bath someone without making him wet. Same with AN.
Keep feeding. There is light at the end of the tunnel.
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